Publications by authors named "Masamitsu Kuwahara"

46 Publications

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation.

Int J Surg Case Rep 2021 Apr 5;82:105860. Epub 2021 Apr 5.

Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara, 634-8522, Japan. Electronic address:

Introduction: Implant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].

Presentation Of Case: A 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.

Discussion: Factors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.

Conclusion: Intermittent suction worked well in this patient and, thus, warrants further study.
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http://dx.doi.org/10.1016/j.ijscr.2021.105860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045035PMC
April 2021

High Expression of Lactate Dehydrogenase A is a Potential Promoter of Malignant Behaviour in Extramammary Paget's Disease.

Acta Derm Venereol 2021 Jan 25;101(1):adv00379. Epub 2021 Jan 25.

Department of Dermatology, Nara Medical University, 840 Shijo, Kashihara, Nara 634-8522, Japan. E-mail:

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http://dx.doi.org/10.2340/00015555-3744DOI Listing
January 2021

Severe Skin Ulcer on the Hand Caused by Hemodialysis Shunt-related Venous Hypertension That Required a Skin Graft.

Plast Reconstr Surg Glob Open 2020 Jun 15;8(6):e2917. Epub 2020 Jun 15.

Division of Dialysis Unit, Nara Medical University Hospital, Kashihara, Nara, Japan.

In dialysis patients, peripheral venous hypertension-induced hand ulcers are rare. We report a case in which a severe hand ulcer was treated with skin grafting after shunt ligation. The patient was a 60-year-old woman who been undergoing dialysis for 13 years. Twelve years ago, a shunt was created in her right wrist via a side-to-side anastomosis. Swelling and congestion occurred in the right hand, and skin ulcers developed on the dorsal proximal portions of the index, middle, ring, and little fingers. No central vein obstruction was apparent. The right wrist shunt was explored, and the distal vein was ligated. A new shunt was created at the right elbow, but the proximal end of the vein that was used for the wrist shunt had to be used, resulting in complete cephalic vein occlusion from the wrist to the elbow. The swelling extended to the entire forearm. Four weeks after the wrist and elbow shunts were ligated, conservative treatment had resulted in granulation tissue formation in the ulcers. Debridement and full-thickness skin grafting from the abdomen were performed. Overall, skin graft survival was 75%. In conclusion, in this patient, side-to-end anastomosis of the proximal vein might be appropriate for shunt creation. When venous hypertension is suspected, ensuring an appropriate alternative shunt, promptly detecting the cause of the problem, and appropriate treatment are important. Venous hypertension must be completely resolved before surgery for ulcers.
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http://dx.doi.org/10.1097/GOX.0000000000002917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339252PMC
June 2020

Squamous cell carcinoma developed in a chronic radiation-induced chest wall ulcer that is difficult to undergo thorough preoperative histological examination.

Int J Surg Case Rep 2020 17;72:467-470. Epub 2020 Jun 17.

Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan.

Introduction: We report a case in which squamous cell carcinoma (SCC) developed in a large chronic radiation-induced thoracic ulcer after flap surgery in areas where preoperative histological examinations are difficult.

Presentation Of Case: The patient was a 75-year-old female. She had undergone resection and radiotherapy for left breast cancer 15 years earlier. Six years ago, the ulcer expanded from the subclavian to xiphoid levels, exposing the lung and pericardium. A histopathological examination, which avoided the lung and pericardium, was performed. Inflammation was diagnosed. We reconstructed the chest wall with a pedicled rectus abdominis flap. Eighteen months later, three verrucous tissue-lined fistulas formed. A histological examination revealed well-differentiated SCC. Six months later, the patient died of massive bleeding from a fistula.

Discussion: It is unclear exactly when the SCC occurred. As three fistulas formed at the margins of the flap around the pericardium, we suspect that the cancer developed within or near the pericardial region. We need to reflect on the lack of a thorough biopsy. As no pericardial biopsy was performed, we should have asked a thoracic/cardiac surgeon to conduct a biopsy during the debridement operation. If the tumor had been localized to the pericardium, it could have been removed.

Conclusion: It is necessary to consider the best method for performing the most thorough histological examination possible, even in areas where histological examinations are difficult, as all ulcers can contain tumors.
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http://dx.doi.org/10.1016/j.ijscr.2020.05.081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317167PMC
June 2020

Acquired agminated melanocytic nevus in the acral area is a potential mimicker of acral lentiginous melanoma: A three-case series report and published work review.

J Dermatol 2020 Jul 4;47(7):770-773. Epub 2020 May 4.

Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan.

Agminated nevus refers to a clustered group of melanocytic nevi confined to a localized area of the body. It rarely involves acral skin, but recognition of acquired agminated nevus (AAN) in the acral area is clinically important because it may mimic acral lentiginous melanoma (ALM). However, acral AAN has only been described in a few case reports and its clinical characteristics remain unclear. We report three additional cases of acral AAN to further analyze the differential points between ALM. Clinical images, including those of dermoscopy, of three cases of acral AAN were reviewed. The lesions were located on the sole or lateral border of the foot. All acral AAN were flat and large in size (>20 mm in greatest dimension), and associated with asymmetry and irregular border. However, no parallel ridge pattern suggesting ALM was observed on dermoscopy. In two patients, the lesions on the sole were totally resected; microscopic evaluation of these two lesions confirmed junctional nests of banal melanocytes. AAN lesions on the sole with chronic mechanical pressure are slightly larger and more diffuse; thus, they may be more likely to be overdiagnosed as malignancy upon inspection than those in the non-acral area. Understanding the concept of the disease and careful dermoscopic evaluation leads to an accurate diagnosis.
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http://dx.doi.org/10.1111/1346-8138.15353DOI Listing
July 2020

Adult-onset Asymmetrical Lipomatosis.

Acta Derm Venereol 2020 Mar 12;100(6):adv00080. Epub 2020 Mar 12.

Department of Dermatology, Nara Medical University Hospital, 840 Shijo, Kashihara, Nara 634-8522, Japan.

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http://dx.doi.org/10.2340/00015555-3439DOI Listing
March 2020

First case report of the coexistence of hydrophilic polymer embolism and cholesterol crystal embolism associated with an endovascular procedure.

J Dermatol 2020 Mar 7;47(3):e93-e95. Epub 2020 Jan 7.

Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan.

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http://dx.doi.org/10.1111/1346-8138.15223DOI Listing
March 2020

Grouped apocrine gland component associated with sporadic syringocystadenoma papilliferum: A case report and BRAFV600E mutation analysis of the two components.

J Dermatol 2019 Nov 11;46(11):e395-e398. Epub 2019 Jul 11.

Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan.

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http://dx.doi.org/10.1111/1346-8138.15020DOI Listing
November 2019

Function Preservation of the Upper Lip after Tumor Resection Using Residual Orbicularis Oris Muscle and Attached Levator Labii Superioris Alaeque Nasi.

Plast Reconstr Surg Glob Open 2018 Oct 4;6(10):e1962. Epub 2018 Oct 4.

Division of Plastic Surgery, Nara Medical University Hospital, Nara, Japan.

We report a case, function preservation of the upper lip after tumor resection was possible using residual orbicularis oris muscle and attached levator labii superioris alaeque nasi. Patient was 67-year-old male with squamous cell carcinoma at the vermilion border. The tumor was resected with an 8-mm margin, leaving the oral mucosa as intact as possible. To reconstruct the red lip, we used the oral mucosa as a rotational transposition flap. The white lip was reconstructed with a cheek rotation flap. A levator labii superioris alaque nasi muscle flap, which was attached to the remaining orbicularis oris muscle, was used to increase marginal lip volume. The movement of the reconstructed lip was good. At 9 postoperative months, induration of the red lip was palpable, and we suspected that the blood supply to the levator labii superioris alaque nasi was borderline insufficient. Slight drooping of the reconstructed lip occurred. We dissected this was caused by dissection of mid facial muscles from orbicularis oris muscle to ease downward rotation of the cheek flap and obscure the original nasolabial fold. Although some drooping and induration of the lip occurred, the white and red lip were reconstructed in a single-stage procedure, which resulted in good movement and preserved the function of the orbicularis oris muscle.
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http://dx.doi.org/10.1097/GOX.0000000000001962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250460PMC
October 2018

Anal gland adenocarcinoma in situ with pagetoid spread: a case report.

Surg Case Rep 2018 Jun 25;4(1):63. Epub 2018 Jun 25.

Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.

Background: Anal gland carcinoma with perianal Paget's disease is rare, and anal gland carcinoma in situ is extremely rare. No cases of anal gland carcinoma in situ with pagetoid spread have been previously reported.

Case Presentation: Physical examination in a 75-year-old woman revealed an erythematous, inflamed, perianal skin lesion. Neither colposcopy, cystoscopy, colonoscopy, computed tomography, nor magnetic resonance imaging showed evidence of malignant genitourinary or gastrointestinal lesions. Histopathological examination of a biopsy specimen showed many Paget's cells in the perianal skin lesion and no malignant cells in the rectal or vaginal mucosa. Therefore, primary extramammary Paget's disease of the anogenital region was suspected, and we performed anus-preserving wide local excision. However, immunohistochemistry revealed a diagnosis of secondary extramammary Paget's disease due to adenocarcinoma arising from the anal gland. We therefore proceeded with a radical operation. Histopathological examination showed no residual cancer cells. The final diagnosis was anal gland adenocarcinoma in situ with pagetoid spread in the perianal skin.

Conclusions: This is the first case report of anal gland adenocarcinoma in situ with pagetoid spread. We recommend immunohistochemical analysis of biopsy and locally resected specimens to obtain an accurate diagnosis and determine the appropriate treatment when there is no visible tumor.
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http://dx.doi.org/10.1186/s40792-018-0469-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020090PMC
June 2018

Clear Cell Adenocarcinoma Arising from Endometriosis in the Groin: Wide Resection and Reconstruction with a Fascia Lata Tensor Muscle Skin Flap.

Case Rep Obstet Gynecol 2018 1;2018:2139595. Epub 2018 Apr 1.

Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.

We herein report a case of clear cell carcinoma arising from endometriosis in the groin in a 53-year-old woman. The findings of MRI and FDG/PET-CT indicated a malignant tumor, and surgical biopsy confirmed adenocarcinoma of the female genital tract. The tumor including a part of the abdominal rectus muscle and rectus sheath, subcutaneous fat, skin, and the right inguinal ligament was resected . The defect in the abdominal wall was reconstructed with a fascia lata tensor muscle skin flap. The tumor was composed of clear cell adenocarcinoma arising from extrapelvic endometriosis. The patient received chemotherapy with gemcitabine and carboplatin for 6 cycles and had no evidence of recurrence 7 months after the treatment. We herein described the diagnosis and surgical management of endometriosis-associated carcinoma in the groin.
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http://dx.doi.org/10.1155/2018/2139595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899860PMC
April 2018

Reconstruction of Near-Total Loss of the Upper and Lower Lips due to Purpura Fulminans with Local Tissue and a Dual-Skin Paddled Anterolateral Thigh Flap.

Plast Reconstr Surg Glob Open 2017 Sep 22;5(9):e1505. Epub 2017 Sep 22.

Division of Plastic Surgery, Nara Medical University Hospital, Nara, Japan.

It is difficult to totally reconstruct the lip, achieving good functional and aesthetic results. There have been few reports of reconstructing complete lip defects. Moreover, upper and lower lip necrosis by purpura fulminans has not been reported. We present a case of a 60-year-old male purpura fulminans patient with upper and lower lip necrosis. Fortunately, our patient had retained his oral commissure function. We reconstructed this defect with an orbicularis oris muscle-skin-mucosal pedicled flap derived from the region between the nasolabial folds for upper lip; a similar bipedicled flap for the lower lip and the donor site was closed with a dual-skin paddled anterolateral thigh flap. Postoperative results were satisfactory, that is, no lip tightness or aperture restriction was seen, and symmetry had been achieved. The new lips exhibited complete sensory recovery. Drooling was minimal during rest and feeding. We could select a method that combined the advantages of local and free flaps. We consider our method for this defect is superior to those described in previous studies, in that the restoration of lip sensation and oral sphincter function can be achieved to some extent in 1 stage while preserving the oral commissure function.
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http://dx.doi.org/10.1097/GOX.0000000000001505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640375PMC
September 2017

Pathological characterization of pachydermia in pachydermoperiostosis.

J Dermatol 2015 Jul 11;42(7):710-4. Epub 2015 May 11.

Department of Dermatology, Toho University School of Medicine, Tokyo, Japan.

Pachydermoperiostosis is a rare hereditary disease, which presents with the cutaneous manifestations of pachydermia and cutis verticis gyrata. Histological findings in pachydermia frequently include dermal edema, mucin deposition, elastic fiber degeneration, dermal fibrosis and adnexal hyperplasia. However, the severity of these findings varies between clinical reports, and a systematic multiple-case clinicopathological correlative analysis has not been performed to date. In the present study, we reviewed the skin biopsy specimens obtained from the pachydermia of six pachydermoperiostosis patients. The severity of the characteristic histological features was semiquantitatively evaluated and correlated with the grade of pachydermia. Dermal edema, mucin deposition and elastic fiber degeneration were observed in all cases. Patients with severe pachydermia had sebaceous gland hyperplasia and fibrosis. These results suggest that the triad of mucin deposition, dermal edema and elastic fiber degeneration are found from very early stage pachydermia, and could be considered diagnostic findings. To ensure an earlier diagnosis of pachydermoperiostosis, a biopsy should be taken when a patient has grade 1 pachydermia to determine the presence of this histological triad.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029778PMC
http://dx.doi.org/10.1111/1346-8138.12869DOI Listing
July 2015

Mucinous adenocarcinoma associated with a chronic perianal fistula - a review of cases from a single institution.

Gan To Kagaku Ryoho 2014 Nov;41(12):1866-8

Dept. of Surgery, Division of Plastic Surgery, Nara Medical University.

Purpose: The purpose of this study was to evaluate the clinicopathological features of mucinous adenocarcinoma associated with perianal fistulas (MAF), to assess the importance of preoperative MRI analysis, and to determine the optimal surgery.

Methods: We performed a retrospective analysis of the data from seven patients with MAF treated at our hospital between 2000 and 2013, and herein discuss the importance of preoperative magnetic resonance imaging (MRI) and of radical surgery.

Results: The male to female ratio was 5:2, and the mean age of the patients was 63 years old (28-70). The median duration of chronic fistulation was 16 years (5-40). The tumor extension was classified as II+III+IV in five patients and as II+III in 2 patients according to the Sumikoshi classification, as determned by pelvic MRI. The performed surgeries were 3 abdominoperineal resections with sacral resection and 4 pelvic exenterations with sacral resection. Two local recurrences developed in patients with R1 resection, and 1 distant metastasis occurred in 1 patient with R0 resection.

Conclusion: For patients with MAF, a curative surgical resection is the only definitive treatment that can be expected to provide a good prognosis. The application of the Sumikoshi classification using MRI may provide a precise assessment of the extension of MAF, which can allow the appropriate surgery to be selected for the patients with MAF.
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November 2014

A case of abdominoplasty after removal of giant ovarian cyst.

Plast Reconstr Surg Glob Open 2014 Aug 8;2(8):e195. Epub 2014 Sep 8.

Center for Plastic Surgery, Nara Medical University Hospital, Kashihara, Nara, Japan.

Summary: When treating a giant ovarian cyst, management of inferior vena cava (IVC) syndrome, bleeding, abdominal competence, and cosmetic appearance are difficult. The details of abdominoplasty for patients with such a cyst have not been discussed. We present a patient requiring 85,000 ml of fluid evacuation before surgery.
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http://dx.doi.org/10.1097/GOX.0000000000000150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236356PMC
August 2014

A defect of the abdominal wall with intestinal fistulas after the repair of incisional hernia using Composix Kugel Patch.

Int J Surg Case Rep 2013 29;4(9):793-7. Epub 2013 Jun 29.

Department of Surgery, Nara Medical University, Nara, Japan. Electronic address:

Introduction: In the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia.

Presentation Of Case: The patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap.

Discussion: Enterocutaneous fistulas are a known complication of incisional hernia repairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted.

Conclusion: Extirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.
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http://dx.doi.org/10.1016/j.ijscr.2013.05.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741458PMC
August 2013

A neonatal case of proliferative nodules in a giant congenital melanocytic nevus with histological evaluation.

Int J Dermatol 2014 Apr 24;53(4):e252-3. Epub 2013 Jul 24.

Department of Dermatology, Nara Medical University, Nara, Japan.

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http://dx.doi.org/10.1111/ijd.12282DOI Listing
April 2014

Identification of mutations in the prostaglandin transporter gene SLCO2A1 and its phenotype-genotype correlation in Japanese patients with pachydermoperiostosis.

J Dermatol Sci 2012 Oct 27;68(1):36-44. Epub 2012 Jul 27.

Center for Integrated Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

Background: Pachydermoperiostosis (PDP) is a rare genetic disorder characterized by 3 major symptoms: pachydermia including cutis verticis gyrata (CVG), periostosis, and finger clubbing. Recently, a homozygous mutation in the gene HPGD, which encodes 15-hydroxyprostaglandin dehydrogenase (15-PGDH), was found to be associated with PDP. However, mutations in HPGD have not been identified in Japanese PDP patients.

Objective: We aimed to identify a novel responsible gene for PDP using whole exome sequencing by next-generation DNA sequencer (NGS).

Methods: Five patients, including 2 patient-parent trios were enrolled in this study. Entire coding regions were sequenced by NGS to identify candidate mutations associated with PDP. The candidate mutations were subsequently sequenced using the Sanger method. To determine clinical characteristics, we analyzed histological samples, as well as serum and urinary prostaglandin E2 (PGE2) levels for each of the 5 PDP patients, and 1 additional patient with idiopathic CVG.

Results: From initial analyses of whole exome sequencing data, we identified mutations in the solute carrier organic anion transporter family, member 2A1 (SLCO2A1) gene, encoding prostaglandin transporter, in 3 of the PDP patients. Follow-up Sanger sequencing showed 5 different SLCO2A1 mutations (c.940+1G>A, p.E427_P430del, p.G104*, p.T347I, p.Q556H) in 4 unrelated PDP patients. In addition, the splice-site mutation c.940+1G>A identified in 3 of 4 PDP patients was determined to be a founder mutation in the Japanese population. Furthermore, it is likely that the combination of these SLCO2A1 mutations in PDP patients is also associated with disease severity.

Conclusion: We found that SLCO2A1 is a novel gene responsible for PDP. Although the SLCO2A1 gene is only the second gene discovered to be associated with PDP, it is likely to be a major cause of PDP in the Japanese population.
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http://dx.doi.org/10.1016/j.jdermsci.2012.07.008DOI Listing
October 2012

Aesthetic reconstruction of a defect in the skin of the upper lip using a hatchet flap.

J Plast Surg Hand Surg 2012 Apr;46(2):80-4

Division of Plastic Surgery, Nara Medical University, Kasihara, Nara, Japan.

Reconstruction of the upper lip requires symmetrical reconstruction of the free border according to the aesthetic principle. We have reconstructed this area with a hatchet flap, so that the scars match the subunit line as far as possible by rotation and advancement of the flap. We operated on six patients. The lower pedicled flap was used in 4 cases and the upper pedicled flap in 2, who also needed reconstruction of the vermillion. In one patient the scar did not match the nasolabial fold. For the upper pedicled cases, scars made on the vermillion were not conspicuous. However, trap door deformity occurred in half, which was a disadvantage. We think that our flap is useful, because it leaves a minimal scar in an inconspicuous area.
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http://dx.doi.org/10.3109/2000656X.2012.669193DOI Listing
April 2012

Rare complication after stripping operation: a case report of mycobacterium abscessus infection.

Ann Vasc Dis 2010 2;3(3):232-5. Epub 2010 Dec 2.

Department of Plastic Surgery, Nara Medical University, Nara, Japan.

Mycobacterium abscessus is an acid-fast nontuberculous mycobacterium that grows rapidly in culture. The organism is found in dust, soil, and water and after trauma, it may infect skin and soft tissue. The organism is rarely found in humans, and infections occurring after cardiovascular surgery are rare clinical events. To our knowledge, only a few cases of hemodialysis arteriovenous graft infection and endocarditis caused by M. abscessus have been described. We reported a first case of patient with M. abscessus graft infection after a stripping operation and skin grafting to a left lower leg ulcer.
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http://dx.doi.org/10.3400/avd.cr01010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595785PMC
April 2013

Perforating pilomatricoma on the upper eyelid.

J Craniofac Surg 2006 Mar;17(2):372-3

Division of Plastic Surgery, Nara Medical University, Kashihara, Japan.

We report a rare case of perforating pilomatricoma. A 50 x 40-mm oval nodule, with a whitish scale on its tip, developed on the left upper eyelid of a 43-year-old Japanese woman. There was no history of injury to the left upper eyelid. Histologic examination revealed typical microscopic features of pilomatricoma. In addition, however, an interesting phenomenon was observed: a portion of the tumor mass had extruded from the upper dermis to the skin surface through a perforating epidermal channel in the middle of the tumor. These findings are consistent with the diagnosis of perforating pilomatricoma.
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http://dx.doi.org/10.1097/00001665-200603000-00031DOI Listing
March 2006

Mortality and recurrence rate after pressure ulcer operation for elderly long-term bedridden patients.

Ann Plast Surg 2005 Jun;54(6):629-32

Department of Plastic Surgery, Hikone Central Hospital, Shiga Prefecture, Hikone-Shi Nishiima-chou, Japan.

We operated on 16 sacral pressure ulcers in elderly and long-term residential patients who were immobile as a result of cerebral vascular disease. The mean age of patients was 76 years. Eight ulcers were treated with local fascial flaps and 8 by simple closure. The follow-up period was from 1 to 4 years. Recurrence and mortality rates were examined retrospectively. In the 16 patients, recurrence occurred in 37.5%, and 43.8% died without recurrence. The recurrence rate was 37.5% for local fascial flaps and 37.5% for simple closure. Overall mortality was 68.8% in the follow-up period. Because postoperative death was common, we should not only focus on reducing local pressure but also pay attention to any underlying disease. Because of this high mortality rate, the least invasive procedure possible should be used. Because the recurrence rate of simple closure was the same as for local fascial flaps, simple closure should be considered as a reconstructive method.
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http://dx.doi.org/10.1097/01.sap.0000164465.40841.0bDOI Listing
June 2005

Expression of N-cadherin by skeletal muscle in the degeneration and the degeneration/regeneration processes after nerve injury.

Scand J Plast Reconstr Surg Hand Surg 2004 ;38(4):198-203

Division of Plastic Surgery, Nara Medical University, Nara, Japan.

We investigated the expression of N-cadherin by skeletal muscle during the degeneration and degeneration/regeneration processes using the rat sciatic nerve and gastrocnemius muscle model. The right sciatic nerve was exposed in the mid-thigh region, and the nerve was transsected with small scissors. After then, nerve was sutured (sutured group), or both edges of the resected nerve were turned and sutured to the muscle of each side (unsutured group). At various periods up to 24 weeks after the operation the middle portion of the gastrocnemius muscle of the treated hindlimbs was removed. Expression of N-cadherin was detected by western blot analysis and immunofluorescent staining with an anti N-cadherin antibody. In the both groups, the degree of expression had already increased by the end of the first postoperative week, but there were no significant differences between the first and second postoperative weeks between the two groups. However, the values recorded at the fourth, sixth, ninth, and twelfth postoperative weeks were significantly higher in the unsutured group than in the sutured group. Immunofluorescent staining was present around the muscular membrane in all specimens including the control. These results indicated that there was a difference in the kinetics of expression of N-cadherin in skeletal muscle between the degeneration and degeneration/regeneration processes of the muscle after injury to the nerve. It was also clear that N-cadherin has a role at the surface of the muscle cell in skeletal muscle, not in the satellite and inflammatory cells, in both groups.
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http://dx.doi.org/10.1080/02844310410026735DOI Listing
April 2005

Reconstruction of a partial maxilla with a combination of autologous bone particles and a microtitanium mesh tray covered by a forearm flap.

J Oral Maxillofac Surg 2004 May;62(5):638-42

Department of Oral and Maxillofacial Surgery, Miyakonoji National Hospital, Miyazaki, Japan.

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http://dx.doi.org/10.1016/j.joms.2003.06.018DOI Listing
May 2004

Expression of N-cadherin and alphaN-catenin in the degeneration/regeneration process of rat skeletal muscle after nerve injury.

J Reconstr Microsurg 2004 Apr;20(3):267-73

Division of Plastic Surgery, Nara Medical University, Kashihara, Japan.

The authors investigated the expression of N-cadherin and alphaN-catenin (which is strongly related to N-cadherin function) in the denervation/reinnervation process using a rat sciatic nerve and gastrocnemius model. In a rat model, the right sciatic nerve was exposed at the mid-thigh region, and the nerve was transected with small scissors. Then, the nerve was sutured using 10-0 monofilament perineurial nylon sutures. At various periods up to 24 weeks after the operation, the gastrocnemius muscle of the treated hindlimbs was removed. Four rats were used at each time point in both groups. N-cadherin and alphaN-catenin expressions were detected by Western blot analysis and immunofluorescent staining with anti N-cadherin and alphaN-catenin antibodies. The level of N-cadherin was already elevated in the first postoperative week, and the level in the second postoperative week was almost the same as in the first. The level decreased gradually after the fourth postoperative week and, in the ninth postoperative week, returned to almost the same as the control level. The level of alphaN-catenin was almost the same as the control (1.0) within the second postoperative week. After the fourth postoperative week, the level elevated gradually, with a peak in the sixth postoperative week. The level then decreased and returned almost to that of the control after the twelfth postoperative week. Immunofluorescent staining was observed along the muscular membrane in all specimens of both proteins, and the time course of the degree of immunofluorescent staining was similar to the results of Western blot analysis. These results suggest that N-cadherin and alphaN-catenin expressions are elevated in the degeneration/regeneration processes of the muscle after nerve injury, but that the kinetics between the two proteins differ.
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http://dx.doi.org/10.1055/s-2004-823115DOI Listing
April 2004

Dermatofibrosarcoma protuberans arising from a burn scar of the axilla.

Ann Plast Surg 2004 Apr;52(4):423-5

Division of Plastic Surgery, Nara Medical University, Kashihara, Nara, Japan.

It is well-known that the development of a malignant tumor in a chronic burn scar is one of the long-term complications of a severe burn. Most of these tumors are squamous cell carcinomas, and sarcomas are much rarely seen in chronic burn scars. In the previous literature, 24 cases of burn scar sarcomas were reported. The authors report the second case of dermatofibrosarcoma protuberans arising in a chronic, severe burn scar. A 68-year-old woman with a reddish tumor in the right axilla was referred to the authors' hospital. The patient had sustained severe burns in the right axilla, upper arm, and trunk at the age of 6 years. A biopsy specimen revealed dermatofibrosarcoma protuberans. There was no evidence of distant metastasis. The tumor was excised widely to include the surrounding burn scar. Two years after the operation, there was no evidence of tumor recurrence. As surgeons, we should recognize the possibility of the occurrence of various malignant tumors including sarcomas on burn scars.
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http://dx.doi.org/10.1097/01.sap.0000100421.95683.9bDOI Listing
April 2004